RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00901
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070726 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Heavy Construction Equipment Operator, medically separated for “bilateral plantar fasciitis” with a disability rating of 0%.  

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070613	VARD -  NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	0%	No VA Examination Proximate to Separation in Evidence	
Backache	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis.  The PEB combined the left and right plantar fasciitis conditions under a single disability rating, coded 5399-5310 (Group X Function: movements of forefoot and toes) and rated 0%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s condition of bilateral plantar fasciitis began in March 2005 without injury.  At the 4 April 2006 primary care clinic (PCC) visit, the CI complained of heel pain.  At the 5 July 2006 PCC visit, the CI complained of bilateral foot pain.  On examination, there was diffuse tenderness over the plantar aspect of both feet, but the CI had full range of motion (ROM) and a normal gait.  At the 10 August 2006 PCC visit, the CI complained of gradually worsening bilateral foot pain over the past year.  On examination, there was tenderness at the anterior heel, but no edema or erythema and full ROM.  

At the 6 January 2007 PCC visit, 6 months prior to separation, the examiner noted fallen arches in both feet with tenderness of both heels.  There was no erythema or abnormal warmth of either foot and no motor dysfunction or peripheral neuropathy.  The gait and stance were normal.  X-rays were normal with the exception of mild pes planus, bilaterally.  

At the 11 April 2007 MEB NARSUM examination, 3 months prior to separation, the CI complained of bilateral foot pain that was aggravated by prolonged standing, jumping, and running activities.  The examiner reported the CI was intact neurologically to light touch distally bilaterally. The CI had good pedal pulses bilaterally, good capillary refill, and warm feet with no edema.  There was pain to palpation right greater than left at the medial calcaneal tubercle.  There was full ROM of the ankle, subtalar joint, metatarsal joint, and metatarsophalangeal joint with no crepitus.  There was positive pain with weight-bearing at the heel with prolonged standing, bilaterally.  The diagnosis was bilateral plantar fasciitis secondary to pes planus deformity.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral plantar fasciitis condition 0%, coded 5310.  The panel first considered if each foot, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  In this case, both feet were considered to fail retention standards, both were implicated by the NARSUM and the commander’s statement, and both were profiled.  Panel members agreed that each foot was separately unfitting.  

The panel noted that the evidence did not support a 10% rating for each foot as moderate muscle dysfunction.  However, the panel noted that there was pain on manipulation and use of the feet that warranted a 10% rating coded analogously to 5276 (pes planus) for moderate bilateral foot disability.  The evidence did not support the severe level because there was no swelling with use or characteristic callosities.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for bilateral plantar fasciitis, coded 5299-5276.  

Contended PEB Condition:  Backache.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis, the panel recommends a disability rating of 10%, coded 5299-5276 IAW VASRD §4.71a.  In the matter of the contended backache condition, the panel recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bilateral Plantar Fasciitis	5299-5276	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004953, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

Sincerely,					      
Enclosure